Fluke co-founded the New York Statewide Coalition for Fair Access to Family Court,[14][15][16][17][18] which successfully advocated for legislation granting access to civil orders of protection for unmarried victims of domestic violence, including teen LGBTQ victims. Fluke was also a member of the Manhattan Borough President's Taskforce on Domestic Violence and numerous other New York City and New York State coalitions that successfully advocated for policy improvements impacting victims of domestic violence.[12][17][18][19] While in New York City, she worked for Sanctuary for Families, which aids victims of domestic violence and human trafficking.[12][20]

Fluke enrolled at Georgetown University Law Center. In an interview with Sarah Kliff of the Washington Post, Fluke stated that she had researched the Jesuit college’s health plans for students before enrolling, and found that birth control was not included, telling her "I decided I was absolutely not willing to compromise the quality of my education in exchange for my health care”.[21] In 2011, Fluke was a recipient of the Women Lawyers of Los Angeles' Fran Kandel Public Interest Grant from Georgetown University Law Center,[20] which supported her production of a video on how to take out a restraining order.[22] She also "represented numerous victims of domestic violence and human trafficking"[17] and worked to help child victims of domestic human trafficking in Kenya.[23] She served as president of the Georgetown Law Students for Reproductive Justice student organization,[24]

Sandra Fluke reading a prepared statement for U.S. Congressional testimony, February 16, 2012

While a law student at Georgetown, Fluke was invited by Democrats to speak at a hearing by the House Oversight and Government Reform Committee on new Administration rules concerning the Conscience Clause exceptions in healthcare associated with the Patient Protection and Affordable Care Act.[26] The exception applied to church organizations themselves, but not to affiliated nonprofit corporations such as hospitals, which do not rely primarily on members of the faith as employees.[27] In addition, another exception was created for religious institutions in which an employee can seek birth control directly from an insurance company rather than nonprofit religious organizations.[28] Democrats requested that the committee add Sandra Fluke to the first panel, which was composed entirely of clergy and theologians. Committee chairman Darrell Issa, a Republican congressman from California, refused, stating that Fluke lacked expertise, was not a member of the clergy, and her name was not submitted in time for the hearing.[26][29] Democratic members criticized the decision not to include Fluke since it left the panel with only male members,[30] when the purpose of the hearing was to discuss contraception coverage.[31]

The following week, the House Democratic Steering and Policy Committee convened a meeting to invite Fluke to speak. She put forward reasons why Georgetown University should be compelled to offer health care that covers contraceptive drugs, in spite of the Catholic university's moral opposition to artificial birth control.[26] She also stated that 40% of Georgetown Law School's female population suffered financial hardship as a result of birth control not being covered by the student health insurance plan, and that the lack of contraception coverage in the university insurance plans would induce many low-income students to go without contraceptives. Fluke insisted that the women of Georgetown, other religious schools, and employees of religious institutions such as hospitals have endured "financial, emotional and medical burdens because of this lack of contraceptive coverage".[32] She then shared stories of friends affected by such policies, citing a friend with polycystic ovary syndrome. Fluke stated this friend needed contraceptive hormones costing over $100 per month to treat the disease, and that while PcOS was "covered by Georgetown insurance", the insurance company repeatedly denied contraceptives because they suspected the purpose of the medication was for contraceptive uses.[32][33][34]

On February 29, 2012, Rush Limbaugh labeled Sandra Fluke a "slut" and "prostitute" based on her speech before House Democrats. Fluke appeared to support mandating health insurers to cover contraceptive costs. Limbaugh stated:[35][36]

"[Fluke] essentially says that she must be paid to have sex—what does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex. She's having so much sex she can't afford the contraception. She wants you and me and the taxpayers to pay her to have sex."

Political figures, including President Obama and Republican House Speaker John Boehner, voiced disapproval of Limbaugh's comments.[37] On March 3, Limbaugh apologized to Fluke for his comments, saying his "insulting word choices" were meant to be "humorous", and that he never believed her to be a "slut" or a prostitute.[38][39] Fluke rejected the apology as dubious and inadequate.[40]

On June 14, 2012, CNN published an op-ed piece by Fluke titled "Why this election is so personal" in which she gave several reasons why she believed Barack Obama was more likely than Mitt Romney to improve the lives of the American people. In the piece, Fluke specifically mentioned President Obama's support of the Lilly Ledbetter Fair Pay Act, increasing the government's investment of Pell Grant scholarships, and the Patient Protection and Affordable Care Act to support her argument.[41] Fluke also introduced President Obama at a campaign rally in Denver on August 8, 2012[42] and was a featured speaker at the 2012 Democratic National Convention, where she addressed the different visions of the role of women in the election.[43][44][45][46][47][48] Her speech was criticized by opponents—most notably by congressman Joe Walsh of Illinois--[49][50] as an example of the Democrats' desire to avoid focusing on the economy and catering to their base.[51][52] Several opinion writers have remarked that the continuing criticism of Fluke has served to revisit the Limbaugh controversy and change the topic of debate to reproductive issues.[53][54] Following this, she received other invitations to speak on the issue of reproduction at various conferences and lectures.[55][56]